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World J Gastrointest Endosc. Apr 16, 2012; 4(4): 123-136
Published online Apr 16, 2012. doi: 10.4253/wjge.v4.i4.123
Endoscopic submucosal dissection for removal of superficial gastrointestinal neoplasms: A technical review
Noriaki Matsui, Kazuya Akahoshi, Kazuhiko Nakamura, Eikichi Ihara, Hiroto Kita
Noriaki Matsui, Department of Gastroenterology and Hepatology, National Hospital Organization Fukuoka Higashi Medical Center, Koga 811-3195, Japan
Kazuya Akahoshi, Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
Kazuhiko Nakamura, Eikichi Ihara, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
Hiroto Kita, Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka 350-1298, Japan
Author contributions: Matsui N, Akahoshi K, Nakamura K, Ihara E and Kita H contributed to the conception of this article; and Matsui N wrote the paper.
Correspondence to: Noriaki Matsui, MD, PhD, Department of Gastroenterology and Hepatology, National Hospital Organization Fukuoka Higashi Medical Center, Chidori 1-1-1, Koga 811-3195, Japan. matsuino@fukuokae2.hosp.go.jp
Telephone: +81-92-9432331 Fax: +81-92-9438775
Received: October 13, 2011
Revised: November 13, 2011
Accepted: March 30, 2012
Published online: April 16, 2012
Abstract

Endoscopic submucosal dissection (ESD) is now the most common endoscopic treatment in Japan for intramucosal gastrointestinal neoplasms (non-metastatic). ESD is an invasive endoscopic surgical procedure, requiring extensive knowledge, skill, and specialized equipment. ESD starts with evaluation of the lesion, as accurate assessment of the depth and margin of the lesion is essential. The devices and strategies used in ESD vary, depending on the nature of the lesion. Prior to the procedure, the operator must be knowledgeable about the treatment strategy(ies), the device(s) to use, the electrocautery machine settings, the substances to inject, and other aspects. In addition, the operator must be able to manage complications, should they arise, including immediate recognition of the complication(s) and its treatment. Finally, in case the ESD treatment is not successful, the operator should be prepared to apply alternative treatments. Thus, adequate knowledge and training are essential to successfully perform ESD.

Keywords: Attachments; Complication; Endoscope; Electrosurgical unit; Endoscopic submucosal dissection; Endoscopic submucosal dissection device; Injection agent; Sedation; Training